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Diastolic dysfunction of the left ventricle in the absence of systolic dysfunction is an entity which is being increasingly recognized. Diastolic dysfunction is impaired relaxation of the left ventricular myocardium and milder degrees of left ventricular dysfunction is quite common as the age advances. One of ofen displayed echocardiographic signs of diastolic dysfunction is the E / A reversal in mitral Doppler studies. Normal mitral diastolic flow is more in the early diastole and there is an additional accentuation of flow in late diastole due to atrial systole. The initial rapid filling of the left ventricle produces the E wave in mitral Doppler tracing and the late diastolic flow due to atrial contraction produces the A wave. Normally the E wave is taller than the A wave as the early diastolic flow is more rapid. When the ventricle becomes stiffer due to diastolic dysfunction, the early diastolic flow decreases and the atrial systolic flow increases. The contribution of atrial systole to ventricular filling may increase from the usual 15% to over 30% in diastolic dysfunction. This causes E/A reversal, which is easy to pick up by Doppler interrogation of the trans mitral flow.